Pregnancy-associated acute liver disease and acute viral hepatitis: differentiation, course and outcome.
OBJECTIVE
Pregnant women with acute viral hepatitis (VH) and those with pregnancy associated acute liver disease (PAALD) including acute fatty liver disease of pregnancy, hemolysis elevated liver enzyme and low platelet syndrome present with similar clinical features and liver tests abnormalities. Accurate differentiation between the two groups is critical to expedite early delivery in the latter and prevent progressive liver damage. There is scant data in the literature to differentiate between PAALD and VH.


METHODS
We studied the clinical variables, hematological, biochemical and viral serological tests of 87 consecutive pregnant patients with jaundice from 2000 to 2003.


RESULTS
There were 46 and 41 patients in PAALD and VH group, respectively. Two-thirds in VH group were due to hepatitis E. Univariate analysis identified hypertension, encephalopathy, oliguria, ascites, serum creatinine, and low platelets as significantly more common in the PAALD group. Multivariate analysis and recursive partitioning identified hypertension and ascites as predictors of PAALD with excellent predictive ability and c value of 0.92. Mortality was 41% in PAALD and 7.5% in VH. Increased bilirubin and oliguria were predictors of mortality in PAALD.


CONCLUSIONS
Presence of ascites and hypertension differentiates PAALD from VH and should prompt early delivery. Mortality due to hepatitis E is low.
Devarbhavi
Harshad
H
Department of Gastroenterology, St. John's Medical College Hospital, Bangalore, India. harshad.devarbhavi@gmail.com
Kremers
Walter K
WK
Dierkhising
Ross
R
Padmanabhan
Lakshmi
L
D000208:Acute Disease; D000328:Adult; D003937:Diagnosis, Differential; D005234:Fatty Liver / Q000175:diagnosis* / Q000401:mortality / Q000821:virology*; D005260:Female; D017359:HELLP Syndrome / Q000175:diagnosis / Q000401:mortality; D016751:Hepatitis E / Q000175:diagnosis / Q000401:mortality; D006525:Hepatitis, Viral, Human / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D006973:Hypertension / Q000175:diagnosis; D017114:Liver Failure, Acute / Q000175:diagnosis / Q000401:mortality / Q000821:virology; D016015:Logistic Models; D015999:Multivariate Analysis; D011225:Pre-Eclampsia / Q000175:diagnosis / Q000401:mortality; D011237:Predictive Value of Tests; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000401:mortality / Q000821:virology*; D055815:Young Adult